Rhode Island ranks among the highest in the country in illicit drug use, including the non-medical use of prescription painkillers and per capita overdose deaths.
In the first four months of 2014, 90 Rhode Islanders died from accidental drug overdoses, a 23% increase from the 73 drug overdoses reported during the same period last year.

The new guidelines state that emergency room doctors should limit prescriptions for short-acting opioid painkillers to a week’s supply, and should not prescribe OxyContin, methadone or extended-release morphine without coordinating with the patient’s primary care physician.

According to the guidelines:

Opioid analgesics may be necessary for the relief of pain, but improper use of opioids poses a threat to the individual and to society. Providers have a responsibility to diagnose and treat pain using sound clinical judgment, and such treatment may include the prescribing of opioids. Providers also have a responsibility to minimize the potential for the abuse and diversion of opioids. Therefore, providers should use proper safeguards to minimize the potential for abuse and diversion of opioids.

Health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every adult in the U.S. to have a bottle of pills, according to the U.S. Centers for Disease Control and Prevention.

The book tells the story of losing my brother Pat, who became addicted to painkillers in high school and died of a heroin overdose at age 20 in February 2009. It also tells the stories of others who have been affected by this epidemic, including parents, former and current addicts, law enforcement officials, harm reduction workers, activists, and doctors. My hope is that telling these stories will help break down the shame and stigma that continue to surround addiction, as well as bring more education and awareness about the painkiller and heroin addiction epidemic that kills 16,000 people a year.

Visit my author website for more information about the book, including upcoming appearances and media interviews.

U.S. Attorney General Eric Holder is urging federal law enforcement agencies to identify, train and equip personnel who may interact with a victim of a heroin overdose with the drug naloxone. The potentially life-saving drug — which effectively restores breathing to a victim in the midst of a heroin or opioid overdose — is already carried by officers in some state and local law enforcement groups while on patrol.

The U.S. Department of Justice wants federal law enforcement agencies, as well as their state and local partners, to review their policies and procedures to determine whether personnel should be equipped and trained to recognize and respond to opioid overdose by various methods, including the use of naloxone, otherwise known as Narcan. Seventeen states and the District of Columbia have amended their laws to increase access to naloxone, resulting in over 10,000 overdose reversals since 2001.

According to Holder:

The shocking increase in overdose deaths illustrates that addiction to heroin and other opioids, including some prescription painkillers, represents nothing less than a public health crisis. I am confident that expanding the availability of naloxone has the potential to save the lives, families and futures of countless people across the nation. Read more...

In Pennsylvania — which ranks among the top 10 states in per capita heroin and opioid deaths— more than 3,000 residents have died from heroin and multi-drug overdoses since 2009, according to this article.

Heroin has recently been dramatically rising in popularity in Pennsylvania: four years ago, 20% of those newly admitted for drug treatment cited heroin as their primary substance of abuse, but the rate has since increased to 23.5%, and the state has about 40,000 heroin users.

Nationwide, the number of people using heroin nearly doubled from 2007 to 2012 to some 669,000 people. Painkiller addicts across the U.S. are turning to the hardcore street drug when pills become too expensive or scarce, according to a letter published in 2012 in the New England Journal of Medicine. Three researchers examined the effect of the abuse-deterrent formulation on the abuse of OxyContin and other opioids, surveying 2,566 people seeking treatment for abuse of or dependence on opioid drugs. Although 24% found a way to defeat the tamper-resistant properties of the abuse-deterrent formulation, 66% indicated a switch to another opioid, with heroin the most common response.

FedEx Corp. is facing charges that it delivered prescription painkillers and other controlled substances for illegal Internet pharmacies.

The charges include 15 counts of conspiracy to distribute controlled substances and misbranded drugs and drug trafficking. Prosecutors claim FedEx delivered drugs to Internet pharmacies that supplied pills to customers who filled out online questionnaires without undergoing doctors’ examinations, in violation of federal and state drug laws.

According to the indictment, FedEx knew as early as 2004 that it was delivering drugs to dealers and addicts:

FedEx’s couriers in Kentucky, Tennessee, and Virginia expressed safety concerns that were circulated to FedEx Senior management, including that FedEx trucks were stopped on the road by online pharmacy customers demanding packages of pills, that the delivery address was a parking lot, school, or vacant home where several car loads of people were waiting for the FedEx driver to arrive with their drugs, that customers were jumping on the FedEx trucks and demanding online pharmacy packages, and that FedEx drivers were threatened if they insisted on delivering packages to the addresses instead of giving the packages to customers who demanded them. In response to these concerns, FedEx adopted a procedure whereby Internet pharmacy packages from problematic shippers were held for pick up at specific stations, rather than delivered to the recipient’s address. Read more...

An older form of the powerful prescription painkiller OxyContin that has been banned in the United States is still showing up in some areas of the country, possibly making the journey from Canada, where it is still legal, according to this article. In 2013, the FDA banned generic versions of OxyContin, which could easily be crushed, in favor of a tamper-resistant version produced exclusively by Oxy maker Purdue Pharma under a new patent. The Canadian government has so far continued to approve generic, crushable forms of oxycodone that are highly prone to abuse — though it has recently indicated it may soon force all opioid manufacturers to render their products tamper-resistant.

Heroin use skyrocketed by more than 80% nationwide from 2007 to 2012, with the number of heroin users rising from about 373,000 to 669,000 in 2012, according to this article, which cites data from the federal Substance Abuse and Mental Health Services Administration presented at the U.S. Conference of Mayors in Dallas.

Physicians in the U.S. prescribe enough painkillers to medicate everyone in the country 24 hours a day for a month, and most heroin users start with prescription drugs, the article says.

Meanwhile, new data from the CDC the number of drug poisoning deaths related to heroin jumped by 45% from 2010 to 2011. But the number of people who are dying from overdosing on prescription drugs hasn’t dropped — about half of the 41,340 people who died of drug poisoning in 2011 took prescription opiates, according to this article.

Delaware has put into place emergency prescribing regulations regarding Zohydro, a powerful new painkiller many critics fear may fuel the epidemic of painkiller abuse. Late last year, Zohydro gained FDA approval despite the fact that after its own advisory committee had voted 11-2 against allowing the drug on the market. Since then, 29 state attorneys general have urged the agency to reconsider its decision, and Massachusetts Gov. Deval Patrick even attempted to ban the drug (a federal judge later blocked that order). Delaware Secretary of State Jeffrey Bullock said the regulations were necessary “to address the imminent peril to the public health, safety and welfare of all Delawareans” caused by Zohydro. According to his statement:

The use of this new and dangerous narcotic painkiller known as Zohydro must be monitored closely because the abuse of it can be deadly. It carries even higher risks of abuse than other short-acting formulations.

Zogenix, the maker of Zohydro, recently reported that about 9,000 prescriptions were filled through June 13 since the drug hit the market in March. The company plans to target about 20,000 prescribers it describes as “high decile [extended-release/long-acting] opioid prescribers” who account for 60% of the market, and envisions Zohydro along the lines of the multibillion-dollar market for OxyContin, according to this article.

Two California counties have launched a lawsuit accusing five major pharmaceutical companies of obscuring the addictive effects of OxyContin, Percocet and other powerful opioid painkillers while reaping billions of dollars in profits from the drugs. The companies deceived tens of millions of doctors and patients about the “significant dangers and questionable benefits of prescription opioids” for the treatment of long-term non-cancer pain, according to a complaint filed today in California state court. The five opioid manufacturers — Purdue Pharma, Cephalon, Janssen Pharmaceuticals, Endo Health Solutions, and Actavis — concealed the dangerously addictive nature of the medicines while touting benefits that had no scientific support, in order to expand the market for the drugs and boost profits, the lawsuit alleges.

The complaint charges that the pharmaceutical companies marketed opioids as “rarely” addictive, misrepresented the evidence of their efficacy for treating chronic non-cancer pain, trivialized their serious side effects and falsely assured doctors and consumers that opioids were safer than over-the-counter drugs.

These pharmaceutical companies have a long history of aggressively marketing these dangerous drugs through sophisticated campaigns. These campaigns employ industry-funded professional associations, patient advocacy groups, and physicians to deceive consumers and their doctors about the harms and purported benefits of opioids for treating chronic pain. Read more...